| Pamela Douglas | |
|
6722 Patterson Ave Suite B Richmond VA 23226-3400 | |
| (804) 282-4000 | |
| (804) 282-7799 |
| Full Name | Pamela Douglas |
|---|---|
| Speciality | Counselor |
| Location | 6722 Patterson Ave, Richmond, Virginia |
| Authorized Official Name and Position | Pamela Kavanaugh Douglas (OWNER) |
| Authorized Official Contact | 8042824000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pamela Douglas 6722 Patterson Ave Suite B Richmond VA 23226-3400 Ph: (804) 282-4000 | Pamela Douglas 6722 Patterson Ave Suite B Richmond VA 23226-3400 Ph: (804) 282-4000 |
| NPI Number | 1952582850 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 11/19/2007 |
| Medicare PECOS PAC ID | 5890740245 |
|---|---|
| Medicare Enrollment ID | O20050317000987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952582850 | NPI | - | NPPES |
| C09408 | Other | VA | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0015000655 (Virginia) | Primary |
| Provider Name | Pamela K Douglas |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1003801028 PECOS PAC ID: 7517912967 Enrollment ID: I20050321000586 |
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